Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.005618
Jornal Vascular Brasileiro
Case Report

O impacto da tecnologia no tratamento do trauma vascular iatrogênico cervicotorácico: estudo de dois casos com intervalo de três décadas e revisão da literatura

The impact of technology on treatment of iatrogenic cervicothoracic vascular traumas: a study of two cases three decades apart and a review of the literature

Victor Bilman, Bernardo Massière, Alberto Vescovi, Daniel Leal, Paula Vivas, Bruno Demier, Arno von Ristow

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Resumo

Complicações relacionadas ao acesso venoso cervicotorácico, como os pseudoaneurismas (PAs), podem ser devastadoras. Neste artigo, apresentamos dois casos semelhantes em que o avanço tecnológico impactou no diagnóstico, tratamento e resultados. Ambos pacientes apresentaram volumoso PA após a tentativa de punção venosa profunda. O primeiro caso, em 1993, diagnosticado por duplex scan, revelou grande PA oriundo da artéria subclávia direita. A artéria foi abordada por esternotomia mediana com extensão supraclavicular. O PA originava-se do tronco tireocervical, tratado com simples ligadura. No segundo caso, em 2017, angiotomografia revelou um PA originário da artéria vertebral, que foi tratado com técnica endovascular, mantendo a perviedade do vaso. Ambos evoluíram satisfatoriamente, apesar de abordagens bastante diferentes. A lesão vascular cervicotorácica representa um desafio propedêutico e terapêutico, com alto risco de ruptura. Os avanços tecnológicos diminuem os riscos de lesões vasculares com acesso cirúrgico difícil e devem estar entre as opções do cirurgião vascular.

Palavras-chave

falso aneurisma; artéria vertebral; cateterismo venoso central; procedimentos endovasculares; stents metálicos autoexpansíveis.

Abstract

Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access.

Keywords

Aneurysm, false; vertebral artery; central venous access; endovascular procedures; self-expanding metallic stents.

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